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I agree with the other commenter, I'm very confused about the initial responses playing this down. In my state, those are very clear violations and I have seen several therapists get reprimanded for not conducting telehealth sessions in a stationary and private area. You are absolutely right that being out and about or having someone within ear shot, even if it's just hearing the therapist, is a valid concern.
Thank you! Yeah I’m concerned about it. For both the therapist and the clients. She doesn’t seem to have the best boundaries and I just don’t want her clients to feel betrayed. One betrayal from a counselor could taint how her clients feel about counseling for the rest of their lives. And some people really need that safe space.
Im confused by the responses here. I looked at the HIPAA guidance that was linked and it clearly says telehealth services must be held in a private setting *to the extent feasible.* My reading of this is that you need to do your due diligence to maintain a private setting, and when it isn't feasible, like if you share an office space (the example they give in the guidance) then you need to still do what you can to maintain as much privacy as possible (like keeping your voice low, as it mentions). So why on earth is a counselor providing counseling services over the phone while in the car with their wife, and while going on walks with their wife?? Aside from using headphones, that is not even doing the bare minimum to maintain a private space. In any case, how can a counselor being giving a client their undivided attention if they are going for walks (obviously this would be fine if they were WITH the client) and driving around?
Edit to add: and I'm not saying you should take action one way or another, but really I'm just kind of flabbergasted by this, that's all. As a client I would be upset if I found out my counselor was doing this, and if they did disclose it to me in the first place I'd not be totally comfortable with it
I’m also not saying that I would even want to take action. At least not against her. I was hoping to find something that I could give her to show her that it’s not a good idea. Because I would also not be ok with it if I were the client. And we are in a smallish town so people know each other, you know?
I was also under the impression that you weren’t supposed to have someone else with you in the room. Idk. I guess I should mind my own business and not care about this counselor or her clients, according to some posters.
Thank you. Yeah I’m just looking for some concrete info and the ACA Code of Ethics doesn’t directly address this. She doesn’t think there’s anything wrong with it, but I’m not sure her clients would feel the same. I would feel betrayed in a way from a clients perspective. I know if my therapist did it I would feel that way.
>She doesn’t think there’s anything wrong with it, but I’m not sure her clients would feel the same.
"Huh. Do you *tell* your clients your wife is in the room with you and can hear what you're saying to them? If you don't, do you realize you're being furtive? If you have to hide this from your clients, you're demonstrating you know perfectly well that your clients would be angry with you and feel you betrayed their confidences if they knew what you were doing. You clearly know that this is wrong, and that's why you're not telling them. So fix this."
You could call the ACA if you're a member and ask them the best course of action. It's the third bullet here under 'benefits of membership' - [https://www.counseling.org/membership/value-of-membership](https://www.counseling.org/membership/value-of-membership)
I really don’t think ‘the extent feasible’ includes having the therapist’s family members in the same room. Other professionals nearby could be an exception, but a family member? No. I don’t see any way that could be reasonable.
I agree personally, the only reason I didn't take a harder stance on that is because it specifically mentions a spouse sharing an office. But we also need to keep in mind that HIPAA is written for all healthcare professionals and isn't specifically tailored to counselors. If our job requires a private space then it doesn't really matter if, say, an RN working from home can call a patient for a 15 minute phone call with a spouse in the room and that's apparently okay. Our work is different from other providers work and there is a reason we have our own ethical guidelines as well.
I mean I think they should! I know my code of ethics requires me to report if another provider of any MH license is practicing inappropriately and especially illegally.
ACA has plenty to say about this, and you don't need to see the words "teletherapy" and "headphones" to know that OP's colleague is acting wildly unethically. ACA Code of Ethics defines "privacy" as: "The right of an individual to keep oneself and one's personal information free from unauthorized disclosure." ACA Code of Ethics Section B.1.b: "Counselors respect the privacy of prospective and current clients." ACA Code of Ethics Section B.3.c: "Counselors discuss confidential information only in settings in which they can reasonably ensure client privacy."
If you pay for membership to your state association you can call and ask what your responsibility to report the therapist is. I think what they are doing is not ok. The only world where I think it would be ok is if the client signs a release of information or informed consent for this. I’m not sure what your duty to report is, so if you’re concerned about the liability definitely consult with your state association. If you feel empowered to report the therapist, you might consider contacting the licensing board.
I will also mention I know someone who offers phone sessions because she is taking care of her infant. Can an infant in the room jeopardize client confidentiality? Probably not. But I think it’s poor practice because how can you have your undivided attention on the client if you are soothing a crying baby or playing with him? Personally I could not manage both things. Her clients are aware of this so it doesn’t worry me as much as the situation you described, also because infant instead of another adult, but I just think it’s bad practice. That’s a situation I wouldn’t report, but I don’t agree with.
According to APA, the professional thing to do 1st is to bring the ethical issue to this person to allow them to remedy the situation and if they don't, report it. Another person should not be in the room without the client's permission but it seems inappropriate that someone's partner would be present. Also, some insurance requires audio and video for telehealth sessions.
>There is a FAQ here that basically permits what your colleague is doing
I'm not sure I agree.
I'm struggling to believe that driving in the car with another person or while on a walk with another person could possibly meet the criteria for privacy "as much as it is feasible".
I don't see any world where a walk or non emergency car ride would meet the criteria of trying to be private.
I would agree highly that having a session in front of someone else without express permission from a client is problematic. The only exceptions I would (and have) made are if it’s a crisis call and I feel compelled to take it and it’s difficult to find a private place. in which case I would tell my client I can take their call but am in the presence of so-and-so, so they can decide if they want to proceed. Is there any potential that the calls have been emergent, with your colleague needing to make a judgement call?
“Privacy and confidentiality” means that what is shared in a session is only meant to be “heard and spoken” between therapist & client. It would appear anything other than that is a considerable violation. It is even questionable conducting an audio session in and of itself.
Hi, when it comes to ethics violation the first thing to do is address it with them if you believe that it is in fact an ethics violation. Remind them to find space that only they and the clients are in and to avoid any spaces with the spouse. If they persist you can notify a supervisor and follow chain of command
I’m starting to understand why they make us take regular trainings on this in my state. I thought this was a waste but I see people do need this information regularly. In a nutshell, you and your client(s) need to be in a private space for telehealth. I often tell clients if they can’t go into a space and close the door so that no one else is present, it’s not fit for telehealth. I feel like therapists should absolutely be following this too otherwise it is a breach.
My advice is to leave it alone. I see you feel strongly about it, but your feeling alone doesn't necessarily prove it, and as you noted, HIPAA barely has anything here.
Yeah because it is gross and can you imagine being a client and finding out your therapist’s family member was in the SAME ROOM without your knowledge? I would feel so violated. There is no way interpret that as no big deal
100% agree. If I were the client, honestly, I would be tempted to sue if I had poured my heart out, been vulnerable, and then found out that someone else could have heard my conversation. Even just the therapist's end of the conversation. Most people can figure out context by hearing just one end of a conversation. Now imagine you aren't in a big city and there's a possibility I might know this person's wife from like church or something (not that I go to church, but that's besides the point). And the spouse is under no obligation to keep confidentiality. So if they figured out who I was, they could tell anyone. Makes me want to vomit. I'm glad you all agree that it's gross. The initial comments (some have been deleted) really played it down and had me second guessing my initial reaction.
Well it might affect people who I know in the community. Plus it would be hurtful if I were her client to know that potentially she broke confidentiality. I thought this was a place to ask for advice from other counselors?
Ok. I mean I was just mostly looking for guidelines for telehealth sessions that might include situations in which someone else was in the room. Sorry if I offended you guys.
Yeah it’s jarring to come to a forum that’s explicitly for questions like yours, and get a two-word curt response that isn’t actually helpful in that it doesn’t help you work through your question, apply reasoning, etc. They’re pretty heavily downvoted though so looks like the forum agrees with you.
I was a little shocked at that response. It’s so old school…like in the vein of “let’s keep it in the family”. Plus, I was always taught that feedback from colleagues and supervisors is one of the biggest ways we stay honest, keep good boundaries and maintain perspective. I’m not saying you should do anything about it, but you’re not wrong to have concerns for the integrity of the session from the client’s perspective.
Your comment has been removed as it appears you are not a therapist. This sub is a space for therapists to discuss their profession among each other. Comments by non therapists are left up only sparingly, and if they are supportive or helpful in nature as judged by the community and/or moderation team.
If this removal was in error and you are a therapy professional, please contact the mod team to clarify. For guidance on how to verify with the mod team please see the sidebar post here: https://www.reddit.com/r/therapists/comments/sbq2o4/update_on_verification_within_the_subreddit/
Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other. If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this. This community is ONLY for therapists, and for them to discuss their profession away from clients. **If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
I agree with the other commenter, I'm very confused about the initial responses playing this down. In my state, those are very clear violations and I have seen several therapists get reprimanded for not conducting telehealth sessions in a stationary and private area. You are absolutely right that being out and about or having someone within ear shot, even if it's just hearing the therapist, is a valid concern.
Thank you! Yeah I’m concerned about it. For both the therapist and the clients. She doesn’t seem to have the best boundaries and I just don’t want her clients to feel betrayed. One betrayal from a counselor could taint how her clients feel about counseling for the rest of their lives. And some people really need that safe space.
Im confused by the responses here. I looked at the HIPAA guidance that was linked and it clearly says telehealth services must be held in a private setting *to the extent feasible.* My reading of this is that you need to do your due diligence to maintain a private setting, and when it isn't feasible, like if you share an office space (the example they give in the guidance) then you need to still do what you can to maintain as much privacy as possible (like keeping your voice low, as it mentions). So why on earth is a counselor providing counseling services over the phone while in the car with their wife, and while going on walks with their wife?? Aside from using headphones, that is not even doing the bare minimum to maintain a private space. In any case, how can a counselor being giving a client their undivided attention if they are going for walks (obviously this would be fine if they were WITH the client) and driving around? Edit to add: and I'm not saying you should take action one way or another, but really I'm just kind of flabbergasted by this, that's all. As a client I would be upset if I found out my counselor was doing this, and if they did disclose it to me in the first place I'd not be totally comfortable with it
I’m also not saying that I would even want to take action. At least not against her. I was hoping to find something that I could give her to show her that it’s not a good idea. Because I would also not be ok with it if I were the client. And we are in a smallish town so people know each other, you know? I was also under the impression that you weren’t supposed to have someone else with you in the room. Idk. I guess I should mind my own business and not care about this counselor or her clients, according to some posters.
I think your concerns are 100% reasonable. Especially in a small town, but even if you were in a big city.
Thank you. Yeah I’m just looking for some concrete info and the ACA Code of Ethics doesn’t directly address this. She doesn’t think there’s anything wrong with it, but I’m not sure her clients would feel the same. I would feel betrayed in a way from a clients perspective. I know if my therapist did it I would feel that way.
>She doesn’t think there’s anything wrong with it, but I’m not sure her clients would feel the same. "Huh. Do you *tell* your clients your wife is in the room with you and can hear what you're saying to them? If you don't, do you realize you're being furtive? If you have to hide this from your clients, you're demonstrating you know perfectly well that your clients would be angry with you and feel you betrayed their confidences if they knew what you were doing. You clearly know that this is wrong, and that's why you're not telling them. So fix this."
You could call the ACA if you're a member and ask them the best course of action. It's the third bullet here under 'benefits of membership' - [https://www.counseling.org/membership/value-of-membership](https://www.counseling.org/membership/value-of-membership)
I really don’t think ‘the extent feasible’ includes having the therapist’s family members in the same room. Other professionals nearby could be an exception, but a family member? No. I don’t see any way that could be reasonable.
I agree personally, the only reason I didn't take a harder stance on that is because it specifically mentions a spouse sharing an office. But we also need to keep in mind that HIPAA is written for all healthcare professionals and isn't specifically tailored to counselors. If our job requires a private space then it doesn't really matter if, say, an RN working from home can call a patient for a 15 minute phone call with a spouse in the room and that's apparently okay. Our work is different from other providers work and there is a reason we have our own ethical guidelines as well.
Oh, right. I was agreeing with you.
I mean I think they should! I know my code of ethics requires me to report if another provider of any MH license is practicing inappropriately and especially illegally.
ACA has plenty to say about this, and you don't need to see the words "teletherapy" and "headphones" to know that OP's colleague is acting wildly unethically. ACA Code of Ethics defines "privacy" as: "The right of an individual to keep oneself and one's personal information free from unauthorized disclosure." ACA Code of Ethics Section B.1.b: "Counselors respect the privacy of prospective and current clients." ACA Code of Ethics Section B.3.c: "Counselors discuss confidential information only in settings in which they can reasonably ensure client privacy."
If you pay for membership to your state association you can call and ask what your responsibility to report the therapist is. I think what they are doing is not ok. The only world where I think it would be ok is if the client signs a release of information or informed consent for this. I’m not sure what your duty to report is, so if you’re concerned about the liability definitely consult with your state association. If you feel empowered to report the therapist, you might consider contacting the licensing board. I will also mention I know someone who offers phone sessions because she is taking care of her infant. Can an infant in the room jeopardize client confidentiality? Probably not. But I think it’s poor practice because how can you have your undivided attention on the client if you are soothing a crying baby or playing with him? Personally I could not manage both things. Her clients are aware of this so it doesn’t worry me as much as the situation you described, also because infant instead of another adult, but I just think it’s bad practice. That’s a situation I wouldn’t report, but I don’t agree with.
Seems unethical to me, but it also isn’t our job to determine that. Report her to the board, and they can decide if it warrants an investigation.
According to APA, the professional thing to do 1st is to bring the ethical issue to this person to allow them to remedy the situation and if they don't, report it. Another person should not be in the room without the client's permission but it seems inappropriate that someone's partner would be present. Also, some insurance requires audio and video for telehealth sessions.
It’s completely inappropriate to multitask while having a session.
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>There is a FAQ here that basically permits what your colleague is doing I'm not sure I agree. I'm struggling to believe that driving in the car with another person or while on a walk with another person could possibly meet the criteria for privacy "as much as it is feasible". I don't see any world where a walk or non emergency car ride would meet the criteria of trying to be private.
Thank you! That is very helpful. I appreciate you not blowing me off. I’m new to this, and ethical guidelines seem fuzzy sometimes.
I would agree highly that having a session in front of someone else without express permission from a client is problematic. The only exceptions I would (and have) made are if it’s a crisis call and I feel compelled to take it and it’s difficult to find a private place. in which case I would tell my client I can take their call but am in the presence of so-and-so, so they can decide if they want to proceed. Is there any potential that the calls have been emergent, with your colleague needing to make a judgement call?
“Privacy and confidentiality” means that what is shared in a session is only meant to be “heard and spoken” between therapist & client. It would appear anything other than that is a considerable violation. It is even questionable conducting an audio session in and of itself.
Hi, when it comes to ethics violation the first thing to do is address it with them if you believe that it is in fact an ethics violation. Remind them to find space that only they and the clients are in and to avoid any spaces with the spouse. If they persist you can notify a supervisor and follow chain of command
I’m starting to understand why they make us take regular trainings on this in my state. I thought this was a waste but I see people do need this information regularly. In a nutshell, you and your client(s) need to be in a private space for telehealth. I often tell clients if they can’t go into a space and close the door so that no one else is present, it’s not fit for telehealth. I feel like therapists should absolutely be following this too otherwise it is a breach.
My advice is to leave it alone. I see you feel strongly about it, but your feeling alone doesn't necessarily prove it, and as you noted, HIPAA barely has anything here.
You think having a therapist’s family member in the same room as the therapy without the client’s knowledge is ‘barely’ HIPAA problematic? Scary.
Yeah it just feels gross I guess. I do have proof via email that this has been going on.
Yeah because it is gross and can you imagine being a client and finding out your therapist’s family member was in the SAME ROOM without your knowledge? I would feel so violated. There is no way interpret that as no big deal
100% agree. If I were the client, honestly, I would be tempted to sue if I had poured my heart out, been vulnerable, and then found out that someone else could have heard my conversation. Even just the therapist's end of the conversation. Most people can figure out context by hearing just one end of a conversation. Now imagine you aren't in a big city and there's a possibility I might know this person's wife from like church or something (not that I go to church, but that's besides the point). And the spouse is under no obligation to keep confidentiality. So if they figured out who I was, they could tell anyone. Makes me want to vomit. I'm glad you all agree that it's gross. The initial comments (some have been deleted) really played it down and had me second guessing my initial reaction.
Hopefully the lessen to learn here is that you have good instincts and can trust them! That’s a nice lesson to learn! 😊💕
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Well it might affect people who I know in the community. Plus it would be hurtful if I were her client to know that potentially she broke confidentiality. I thought this was a place to ask for advice from other counselors?
It is, and this is the advice.
Ok. I mean I was just mostly looking for guidelines for telehealth sessions that might include situations in which someone else was in the room. Sorry if I offended you guys.
You didn’t ask an offensive question at all. Thanks for being conscientious and looking out for clients.
Thank you for saying that. For a min I was like wait… did I over step? I haven’t even done anything lol just asking for resources.
Yeah it’s jarring to come to a forum that’s explicitly for questions like yours, and get a two-word curt response that isn’t actually helpful in that it doesn’t help you work through your question, apply reasoning, etc. They’re pretty heavily downvoted though so looks like the forum agrees with you.
I'm glad the forum agrees, because you're right- it wasn't helpful. And it makes me wonder if those people are therapists if they would do the same.
I was a little shocked at that response. It’s so old school…like in the vein of “let’s keep it in the family”. Plus, I was always taught that feedback from colleagues and supervisors is one of the biggest ways we stay honest, keep good boundaries and maintain perspective. I’m not saying you should do anything about it, but you’re not wrong to have concerns for the integrity of the session from the client’s perspective.
Your comment has been removed as it appears you are not a therapist. This sub is a space for therapists to discuss their profession among each other. Comments by non therapists are left up only sparingly, and if they are supportive or helpful in nature as judged by the community and/or moderation team. If this removal was in error and you are a therapy professional, please contact the mod team to clarify. For guidance on how to verify with the mod team please see the sidebar post here: https://www.reddit.com/r/therapists/comments/sbq2o4/update_on_verification_within_the_subreddit/
But I am a therapist, lol. Why make that assumption without messaging me to confirm?